Metaphor: Complete or Incomplete*

Using metaphor in therapy, both in the process of joining with a family and as a process in itself within which interventions are delivered, can lead to extraordinary and sometimes unexpected behavioural change. Yet for the therapist beginning to consider the use of therapeutic metaphor the prospect must be daunting when, with a few notable exceptions, the literature suggests the ideal as a complex, isomorphic and often elegant story. This paper attempts to broaden yet simplify technique using clinical example to examine the use of metaphor in language and action in family therapy.     

Using Football Metaphor to Engage Men in Therapeutic Support

This paper is an account of a small scale exploratory study about the use and value of football metaphor as a device for facilitating therapeutic work. It is based on an evaluation which used a range of qualitative and quantitative approaches. In this paper, we selectively draw on the qualitative data to provide examples to inform our discussion. We illustrate various ways in which football metaphor can support therapeutic change: by aiding initial engagement, facilitating mutual support, enabling self-understanding and motivating change. We relate our analysis to the literature about the therapeutic value of metaphor and highlight the salience of using football metaphor in a group-based setting for men who are often seen as ‘hard to engage’ in therapeutic support. With some caveats, we argue that football metaphor offers a potentially rich and flexible therapeutic resource.     

Wrapping and Unwrapping Emotions: Clinical Practice with East Asian Immigrant Elders

Using the cultural norm of the way gifts are wrapped, unwrapped, and exchanged as a metaphor for interpersonal connections, this paper presents the way therapists can establish therapeutic relationships with East Asian clients who do not express emotions openly. We first discuss the ways in which emotions are conceptualized, experienced, and expressed in East Asian cultures. We then present vignettes of our work with older Chinese and Japanese immigrant women to illustrate the importance of therapist authenticity and co-construction of the therapeutic relationship. Using the framework of relational/cultural theory, which posits that healing takes place in the context of mutually empathic growth-fostering relationships, we illustrate the importance of establishing mutuality between therapist and client as a form of cultural empathy.     

More Than Protest: Further Explorations of Alternative Metaphors in Narrative Therapy

In the experience of non‐narratively trained therapists, as well as some narratively trained therapists, the ‘protest metaphor’ for framing externalising conversations retains signature status. Yet this metaphor does not adequately represent the breadth of narrative work. As therapist and client reflecting on our joint work, we explore what using a range of metaphors offers to narratively informed therapeutic work. The concept of ‘resistance practices’ from Stacey (1997) is revisited, alternative metaphors employed in externalising conversations are reviewed, and power is re‐examined. We then review the effects on practice that ensue from drawing on a range of alternative metaphors, illustrating our account with extracts from letters and comments on sessions.     

An Integrated Human Behavior Theory

Abstract

In this article, the behavioral exchange model as derived from the work of Emerson, is presented to help the practitioner more adequately conceptualize the interaction between the clinician and the client. This model can help the clinician develop and further his/her understanding of how power differentials between the clinician and the client affect the therapeutic relationship. This model describes how clients use a cost-benefit framework to determine if treatment is worthwhile-meaning that if the client perceives the rewards of an interaction as not outweighing the costs, then the client may terminate treatment. Finally, this model can assist the clinician in constructing an integrative framework for the diverse variables reviewed in the text, and with this framework will be better equipped to influence them.     

Self-disclosure in clinical social work

This article seeks to establish six guidelines for the use of selfdisclosure in clinical social work. It examines the relationship between self-disclosure and countertransference, the timing of self-disclosure over the course of the therapeutic relationship, types of self-disclosure, the connection between assessment of the client and self-disclosure, and how self-disclosure is related to reality-testing. Objections to self-disclosure are also examined and clinical examples are used throughout.     

A review of the empirical status of tranditional modes of interpersonal helping: Implications for social work practice

The empirical status of traditional modes of interpersonal helping are reviewed in terms of client deterioration, spontaneous remission, and immediate and long-term effects. Necessary therapeutic conditions for client change, such as genuineness, nonpossessive warmth, and accurate empathic understanding, are discussed. Variables contributing to the ineffectiveness of traditional modes of interpersonal helping are elaborated in terms of the following: the medical model of mental disease, behavior as symptoms, diagnosis and treatment, labeling and stigmatization, the training of clinical social workers, conflict models of human behavior, academic achievement and fieldwork practice, criteria for the selection of theories of human behavior and induced change, and the relationship between academic performance and effectiveness in the field of clinical practice. The rationale is presented for a new type of social worker, the behavioral social worker, whose profile is reviewed in terms of knowledge base, behavioral skills, and value base.     

Resolving Therapeutic Impasses by Using the Supervisor's Countertransference

The traditional role-set of the clinical social work supervisor has grown to be much more complex. From the exclusive position of teacher, administrator, and overseer she is now an integral part of a system wherein she is influenced not only by the therapist, client, and her own promptings but is a prime source of feedback to the client through the supervisee.As clinical social workers have shifted their conceptualization of therapy to a two-person psychology, this perspective has emerged as part of the supervisory process. Now the supervisor's countertransference responses to the supervisee, to his client, and to their interaction have assumed importance in supervisory work. This article is an attempt to demonstrate through case illustrations how the supervisor's disclosure of countertransference responses to the supervisee can strengthen the supervisory alliance which then enables the client and therapist to resolve therapeutic impasses.     

Gender differences in client–provider relationship as active ingredient in substance abuse treatment

The client–provider relationship is increasingly evaluated as an active ingredient in the delivery of substance abuse treatment services. This study examines gender differences in client–provider relationship as an important treatment ingredient affecting retention in treatment and reduced post-treatment substance use. The study uses data collected for the National Treatment Improvement Evaluation Study (NTIES), a prospective, cohort study of U.S. substance abuse treatment programs and their clients. Data on individual characteristics were collected at the pre-treatment interview; on client–provider relationship and services received at treatment exit; and on post-treatment drug use at 12 months post-treatment. The analytic sample consists of 3027 clients from 59 service delivery units (1922 men and 1105 women). Structural equation modeling (SEM) was used to assess the structural relations and causal connections between relationship and service variables and treatment outcome variables. Results indicate that a positive client–provider relationship is related directly to longer duration and reduced post-treatment drug use for the total sample and for men analyzed separately. For women, a positive client–provider relationship was related directly to treatment duration and only indirectly to reduced post-treatment drug use. The findings point to the significance of including client–provider relationship in service delivery models – both as a therapeutic element as well as an element facilitative of matching services to specific client needs.     

Constructive hypothesizing,dialogic understanding and the therapist's inner conversation: some ideas about knowing and not knowing in the family therapy session

The primary tasks of the therapist can be described as listening to what the client says and making space for what the client has not yet said. According to Anderson and Goolishian, the therapist should take a not-knowing stance in this dialogic process. The question remains, however, what not-knowing exactly means. In this article, I will explore this question and I will propose the concept of constructive hypothesizing. Constructive hypothesizing is described as a process in which there is a movement back and forth between knowing and not knowing. Of central importance are creative and dialogic understanding, rather than knowledge. Recommendations are made to ensure the constructive and collaborative use of hypotheses in the therapeutic dialogue.     

Lockdown Learnings: No Longer the Mirrored Room

During the COVID‐19 lockdown in Aotearoa/New Zealand, a discussion panel was convened comprising of family therapy students and experienced family therapists to investigate the effects of the use of online digital mediums for family therapy. This article discusses the learnings from that panel. It seems that the use of a screen can change the power dynamic between therapist and client family, perhaps levelling the field slightly and resulting in implications for the therapeutic relationship. Suggestions for practice are given and the situation is likened to that of the ‘mirrored room’ proposed by Hare‐Mustin (1994).     

A meaningful entrance: photo therapy as a psychotherapuetic intervention

Photo therapy is a technique that mental health clinicians can use to motivate therapeutic discussions with clients. The explicit focus is on the photograph rather than on the client; this provides a feeling of emotional safety. Images stimulate clients to project their own interpretations. A picture, used as a therapeutic process tool, provides a meaningful entrance into an undefended side door of the mind to allow for emotional healing.     

Using Social Media to Change the Narrative Around Chronic Illness

Chronic illness is a prevalent issue for many individuals. Various theoretical approaches have been employed in the psychotherapeutic treatment of chronic illness and the effects it has on the individual with the illness. These approaches frequently overlook the strengths of the person living with the illness as well as fail to address aspects of modern life such as social media use of the client and the influence it holds for those living with a chronic illness. This paper proposes the application of narrative therapy and social media use as a narrative therapeutic technique when treating those who suffer from chronic illness. A clinical vignette is used to illustrate possible applications of therapeutic techniques in conjunction with therapist-directed social media use. Implications for clinical practice and limitations are discussed.     

Integrating Art Therapy Methodology in Brief Inpatient Substance Abuse Treatment for Adults

ABSTRACT

Decades of drug addiction research and clinical work have underscored the need for multifaceted and comprehensive treatment responses in order to sufficiently address the varied needs of individuals struggling with addiction. One valuable treatment component that can be incorporated into traditional treatment protocols to expand the comprehensive nature of treatment response is art therapy. A conceptual framework is presented, detailing the integrative opportunities and benefits of including an art therapy component to short-term hospital-based inpatient substance abuse treatment programs. A creative arts component can be particularly beneficial for brief inpatient programs, where the client population is diverse, in crisis, and at high-risk for relapse; and where clinicians need to obtain comprehensive client information from multiple sources in a short amount of time. Art therapy methodology can provide a mechanism for collecting such collateral information for assessment purposes, can be employed to facilitate therapeutic change, and is used to track and document client progress and clinical change over time. Practice guidelines and specific treatment techniques are presented through short case examples.     

Walk-in clinic counselling for emotional regulation with low-needs youth on the autism spectrum

A single-session consultation model for low-needs youth on the autism spectrum is presented with the mental health concern of emotional self-regulation, a common issue in family psychotherapy. This research is contextualised within the growing field of short-term therapy as it intersects the growing demand to therapeutically address clients on the autism spectrum. The treatment intervention is delineated through five sequential phases within the walk-in clinic setting for the practitioner clinician. A rationale, overview, and instruction for the practitioner clinician utilising this novel model is provided through a case study format. By using a more structured and integrated approach to treatment, organised through an externalised metaphor, it is suggested that the current model will be more effective for this specific clinical population. Additionally, a case illustration is provided that scaffolds the treatment model, which includes table formats and pictures. The case study illustrates the self-regulation map metaphor visually and interactively linking client challenges, strategies, and motivations simultaneously on multiple electronic devices in session. Relevant works were selected to explore the effectiveness of single-session consultation models for those presenting on the autism spectrum. Treatment interventions for specific clinical populations are recommended, especially within walk-in clinic therapy. This clinical research introduces a paradigm shift towards therapeutically addressing emotional self-regulation with low-needs youth on the spectrum through virtual, interactive technology.     

This is Common Factors

Common factors are conditions and processes present in, among, and surrounding participants in clinical work. In the past 20 years, increasing attention and research on common factors has generated a great deal of discussion in clinical psychology, psychiatry, marriage and family therapy, and to a lesser extent, social work. While there is no single definition of common factors, they are generally discussed as the non-technical aspects of therapeutic work—such as the relationship between the practitioner and client and the expectancy of the client—that have been shown to be associated with successful outcomes. Common factors also include attributes of the practitioner and client, the support system of the client, the institutional and organizational conditions in which the practitioner practices, and also the strategic actions employed by the practitioner, client, and all those involved in the work that promote change. This paper will discuss key concepts in a common factors practice perspective and how evidence is used by common factors practitioners, highlight features of common factors practice, and suggest implications for developing a common factors practice approach.     

The Devil is in the Detail: Clinicians,Academics and Researchers Resolving the Problems of Clinical Research

The difficulties associated with conducting valid family therapy research within a clinical practice discourage many potential researchers. This article will describe collaboration between a group of academics, researchers and clinicians who decided to explore the process and efficacy of systemic family therapy conducted within a working private practice. The specific questions we are addressing are, whether the requests clients bring to their first session of therapy can be reliably classified by practitioners, whether these requests change over time, and whether the nature of the request is associated with therapist and client ratings of therapeutic outcome. Additional questions about the form and nature of the therapeutic alliance as experienced by both client and practitioner are also being explored. This paper will map the passage of the work from inception to its current state where over 140 clients are active participants. In doing so attention will be paid to the obstacles encountered: practical, financial and ethical, and the solutions devised to address these.     

Clinical Writing of a Therapy in Progress: Ethical Questions and Therapeutic Challenges

Clinical implications and ethical dilemmas of the use of confidential case material in clinical writing are examined, including a review of the discourse among professionals who publish clinical work. This literature is applied to a clinical illustration of psychotherapy with a client who gave consent for publication and read the clinical write-up of her case material. It is suggested that clinical writing may increase client “self-reflection” if there is a “secure base” of attachment between therapist/author and the client. The impact on the client’s treatment process is examined, in addition to a discussion of ethical questions and professional recommendations. ²Dr. Susanne Bennett is an Assistant Professor, National School of Social Service of the Catholic University of America. Dr. Bennett is also a psychotherapist in private practice in Falls Church, VA.     

Integrating three approaches to counter resistance in a noncompliant elderly client

1. The term "resistance' has been defined primarily in the psychoanalytic literature and is a significant issue in the treatment of mentally ill people. This issue needs to be addressed for the change process to begin. 2. An understanding of resistance from psychoanalytic, cognitive, and behavioral perspectives will enable the nurse to assist the client in achieving mental health. 3. Countertransferance can be used to understand the client's motives, hence becoming aware of therapeutic goals, or it can hinder the therapeutic process. 4. The psychiatric-geriatric population is complex. With the acceptance that an elderly client can benefit from psychotherapy and with an understanding of different approaches, the client may experience symptom relief.     

A Dialogical Model for Engaging Spirituality in Therapy

This article addresses the issue of engaging client diversity in therapeutic practice by elaborating a dialogical model of engagement that is sensitive to and inclusive of the spiritual dimension in the therapeutic encounter. Drawing on Martin Buber’s writings on the ‘I–Thou’ relationship, the concept of intersubjectivity, research on spirituality in therapy, and the authors’ clinical experiences of collaboratively engaging the spiritual dimension in therapy, strategies of engagement are critically examined. Treatment benefits of practices that facilitate the inclusion of client spiritual values and beliefs in the therapeutic conversation are explored and potential therapeutic pitfalls are identified.